Online Treatment for Pediatric Recurrent Pain

OVERVIEW

The main purpose of this study was to evaluate the impact of a seven-week internet-based treatment program for pediatric recurrent pain patients.  Forty-seven children and adolescents were randomly assigned. The treatment group was compared to patients who were still waiting to receive treatment for their pain.  The goal of this program was to reduce children's pain through reading a web-based manual and having weekly telephone or e-mail contact with a therapist.  The children's pain (e.g. headaches and abdominal pain) was assessed with a pain diary kept by the children that was collected every two weeks.  Researchers assessed the children's pain and quality of life after 1 month and after 3 months participation.  The program considered a 50% reduction in diary pain scores to indicate that the program was effective.  The treatment group achieved a 71% and a 72% reduction in diary pain scores at the 1- and 3- month follow up, whereas the control group achieved only a 19% and a 14% reduction in diary pain scores.  The differences in diary pain scores between treatment and control groups were significant.

DESCRIPTION OF PROGRAM

Target population: Boys and girls between the ages of 9 and 16 years who had varying levels of pain severity (pain levels between high and low).

Children in the seven-week program were asked to keep a pain diary that was collected every two weeks.  The pain diary was used to record the frequency and intensity of the children's pain.  Both the children and the parents of the children in the treatment group were instructed to work through online chapters of a treatment program aimed at improving specific pain reduction skills (e.g., deep breathing, relaxation, visualization, etc.).  They were asked to complete online questions at the end of each chapter.  During the treatment, the participants -- parents and children -- were contacted by e-mail and telephone by therapists to discuss the lessons covered in the chapters.  The children and their parents were also encouraged to contact the therapist if they had any questions.  Children in both the treatment and non-treatment conditions were interviewed 1 and 3 months after the treatment was completed and were asked to complete post-treatment measures.  

EVALUATION OF PROGRAM

Hicks, C. L., Von Baeyer, C. L., and McGrath, P. J. (2006). Online psychological treatment for pediatric recurrent pain: A randomized evaluation. Journal of Pediatric Psychology, 31(7), 724-736.

Evaluated population: 17 boys and 30 girls between the ages of 9 and 16 years with varying levels of head or abdominal pain (ranging in severity from high to low).

Approach: The children were recruited via the media, posters in physicians' offices, and advertisements in school newsletters.  Once the children were accepted into the study, they were separated by age (9-12 and 13-16 years) and pain severity (high and low) and then randomly placed by block in the treatment or non-treatment condition. 

Children in both the treatment and control groups filled out pain diaries before and after the seven-week program.  The pain diary was used to assess pain intensity four times a day over a two-week period. During the intervention, the children in the treatment group learned cognitive-behavioral relaxation techniques and cognitive strategies to reduce pain.  They also received background information on their pain conditions and information about positive lifestyle choices over the internet.  At the end of each online chapter, the child answered questions about the topics covered.  After some chapters, there were questions for the children and parents to answer together.  Each child in the treatment condition also received a personalized relaxation tape and a thought journal.  At the end of the seven-week treatment period, the researchers assessed the children's pain at a 1-month and a 3- month follow-up.      

Results: Before the treatment began, the children in the treatment group and the children in the control group reported similar levels of pain.  After the program, the children in the treatment condition significantly reduced their reported pain  by 71% from the beginning the program to the 1-month follow up and by 72% to the 3-month follow up.  The children in the control group reduced their reported pain by 19% at the 1-month follow up and by 14% at the 3-month follow up.  Since the treatment group's reported pain reduction was more than 300% greater than the control group's pain reduction, there is evidence that the internet/telephone-based treatment was effective in reducing children's pain.      

There was no significant difference, however, between the treatment and control groups when it came to rating quality of life.  It is not clear, however, whether the children's quality of life did not improve at all despite the pain reduction, or whether the quality of life improved for both groups similarly despite the difference in pain reduction.

Recurrent pain produces many types of costs that are direct, indirect, and intangible.  The researchers estimated that the distance treatment applied in this study was 5.5 times more cost-effective with respect to the consumption of therapist time than office-based individual therapy. 

SOURCES FOR MORE INFORMATION

The content of the treatment program was adapted from the Pain Module for the Family Help Project at Dalhousie University.  A summary of the treatment and sample pages of the treatment program can be accessed at: www.usask.ca/childpain/research/hicks/ . 

References

Hicks, C. L., Von Baeyer, C. L., and McGrath, P. J. (2006). Online psychological treatment for pediatric recurrent pain: A randomized evaluation. Journal of Pediatric Psychology, 31(7), 724-736.

Program categorized in this guide according to the following:

Evaluated participant ages: 9-16 years / Program age ranges in the Guide: middle childhood; adolescence

Program components: Provider-based, Internet-based

Measured outcomes: Physical health

Program information last updated 9/12/08